Background : The detection and early elimination of the causes for acute respiratory distress syndrome(ARDS) at the initial stage can result in a more favorable prognosis. Miliary tuberculosis as a cause of the ARDS is quite rare. A diagnosis of miliary tuberculosis is difficult due to the diversity of radiological patterns and non-specific clinical finfings, and low sensitivity of sputum examinations for acid-fast bacilli(AFBs). An analysis of the clinical data is the first step in diagnosing these unusual, rare cases. Materials and Methods : In this study the clinical features, laboratory data, radiological findings and diagnostic methods were analyzed in 9 cases with an initial presentation of ARDS due to miliary tuberculosis. The ARDS was defined by the definition of the American-Europian consensus conference 1992. Results : The mean age of the patients was $67{\pm}18$ years (F:M=7:2). The chief complaints were dyspnea(5/9), coughing (3/9) and fever(5/9). On a physical examination, fine or coarse crackles were noted(6/9). The ARDS developed on average 6.7 days after the initial respiratory symptoms. The mean $PaO_2/FiO_2$ of the patients was $133.5{\pm}53.4$, the number of cases with a WBC<5000/$mm^3$ was 4 out of 9 cases. A platelet count<70,000/$mm^3$ was observed in 2 out of 9 cases, and the serum albumin level was $2.6{\pm}0.6$ g/dL. The initial simple chest PA showed ground glass appearances and consolidation in all cases, However, the miliary nodular densities were observed in only 4 out of the 9 cases. HRCT revealed alveolar densities and a consolidation in 5 out of 6 cases, and miliary nodules in 5 out of 6 cases, The diagnosis of tuberculosis was made by a liver biopsy (4/4, 100% sensitivity), a bone marrow biopsy (1/2, 50% sensitivity), and an open lung biopsy (1/1), the sputum AFB was positive in only 2 out of 9 cases. The patient was treated with INH, RFP, EMB, PZA, and steroids. The survival rate was 55.5%. Conclusion : Miliary tuberculosis should be considered as one of the causes for ARDS in areas where there is a high prevalence of tuberculosis. The chief complaints of the patients on admission are dyspnea, fever and coughing without any specific riskfactors. A liver biopsy is particularly useful in ARDS patients with mechanical ventilation to determine the causes of the ARDS if miliary tuberculosis is suspected as being the underlying disease.
Park, Kwonoh;Lim, Hyoung Gun;Hong, Ji Yeon;Song, Hunho
Journal of Hospice and Palliative Care
/
v.17
no.3
/
pp.179-184
/
2014
Purpose: We investigated the safety and efficacy of peripherally inserted central catheters (PICCs) in terminally ill cancer patients. Methods: A retrospective review was conducted on patients who underwent PICC at the hospice-palliative division of KEPCO (Korea Electric Power Corporation) Medical Center between January 2013 and December 2013. All PICCs were inserted by an interventional radiologist. Results: A total of 30 terminally ill cancer patients received the PICC procedure during the study period. Including one patient who had had two PICC insertions during the period, we analyzed a total of 31 episodes of catheterization and 571 PICC days. The median catheter life span was 14.0 days (range, 1~90 days). In 25 cases, catheters were maintained until the intended time (discharge, transfer, or death), while they were removed prematurely in six other cases (19%; 10.5/1000 PICC days). Thus, the catheter maintenance success rate was 81%. Of those six premature PICC removal cases, self-removal due to delirium occurred in four cases (13%; 7.0/1000 PICC days), and catheter-related blood stream infection and thrombosis were reported in one case, each (3%; 1.8/1000 PICC days). Complication cases totaled eight (26%; 14.1/1000 PICC days). The time to complication development ranged from two to 14 days and the median was seven days. There was no PICC complication-related death. Conclusion: Considering characteristics of terminally ill cancer patients, such as a poor general condition, vulnerability to trivial damage, and a limited period of survival, PICC could be a safe intravenous procedure.
Yu Song Hyeon;Lim Sang Hyun;Hong You Sun;Park Young Hwan;Chang Byung Chul;Kang Meyun Shick
Journal of Chest Surgery
/
v.38
no.8
s.253
/
pp.545-550
/
2005
Background: Discrete subaortic stenosis is known to recur frequently even after surgical resection. We retrospectively reviewed the preoperative and postoperative changes in pressure gradient through left ventricular outflow tract, and the recurrence rate. Material and Method: Between September 1984 and December 2004, 34 patients underwent surgical treatment. Mean age of patients was $17.1\pm15.2$ years and 19 patients $(55.9\%)$ were male, 16 patients $(47.1\%)$ had previous operations and associated diseases were aortic regurgitation (11), coarctation of aorta (3), and others. Result: Immediate postoperative peak pressure gradient was significantly lower than preoperative peak pressure gradient (21.8 mmHg vs 75.8 mmHg, p<0.04). Peak pressure gradient measured after 50.3 months of follow up was 20.2 mmHg which was also significantly lower than that of preoperative value but not significantly different from that of immediate postoperative value. There was no surgical mortality but one patient developed cerebral infarction. Mean follow up duration was $69.8\pm54.6\;months$. During this period, 5 patients $(14.7\%)$ had reoperation, 3 $(8.8\%)$ of whom were due to recurred subaortic stenosis. We found no risk factors for recurrence and survival for free from reoperation was $76.4\%$. Conclusion: Excision of subaortic membrane combined with or without myectomy in discrete subaortic stenosis showed sufficient relief of left ventricular outflow tract obstruction with low mortality and morbidity, but careful long term follow up is necessary for recurrence, since it is not predictable.
The Journal of the Korean bone and joint tumor society
/
v.15
no.2
/
pp.111-121
/
2009
Background: Osteosarcoma is one of the most common primary malignant tumors of bone occurring mainly in children and adolescents. Although surgery combined with chemotherapy has markedly improved patient survival during the last years, the use of anticancer drugs is still associated with serious problem, such as the frequent acquisition of drug-resistant phenotypes and occurrence of "secondary malignancies". Several solid tumors display enhanced expression of matrix metalloproteinases (MMPs), and recently clinical trials have been initiated on MMP-inhibitors. On the other hand, bisphosphonates (BPs) are inhibitors of bone resorption, and widely used to treat osteoclast-mediated bone diseases. Also they appear to possess direct antitumor activity. Methods: One osteosarcoma cell line (U2OS) was treated with ibandronate (0, 0.1, 1, $10{\mu}M$) for 48 hours. Cell viabilities were determined using MTT assay, the mRNA levels of MMP-2 and MT1-MMP were detected by reverse-transcription polymerase chain reaction, the amount of MMP-2 and MT1-MMP protein were measured by Westernblot, the activities of MMP-2 were observed by Gelatin zymography, and Matrigel invasion assays were used to investigate the invasive potential of osteosarcoma cell lines before and after ibandronate treatment. Results: The invasiveness of U2OS cell line was reduced dose-dependently following 48 hour treatment of up to $10{\mu}M$ of the ibandronate at which concentration no cytotoxicity occurred. Furthermore, the gelatinolytic activities and protein and mRNA levels of MMP-2 and MT1-MMP were also suppressed by increasing ibandronate concentrations. Conclusion: Given that MMP-2 is instrumental in tumor cell invasion, it is very likely that the reduction in osteosarcoma cell invasion by ibandronate is a consequence, at least in part, of suppressed expression of both MMP-2 and MT1-MMP. Isolation of a molecule (s) responsible for the bisphosphonate inhibition of tumor cell invasion would pave the way for the development of a new generation of metastasis inhibitors.
Kang Seong-Sik;Jung Sung-Ho;Lee Sang-Gwon;Joo Suk-Jung;Song Hyun;Song Meong-Gun;Lee Jae-Won
Journal of Chest Surgery
/
v.38
no.1
s.246
/
pp.23-28
/
2005
Ross procedure is ideal aortic valve replacement method with several merits of hemodynamic superiority and durability without the need of anticoagulation. Based upon this presumption, we studied its procedure performed in our hospital and tried to get the mid-term results Material and Method: From Jan 1999 to Oct 2001, 22 patients underwent the Ross procedure. The mean age of experimented (including 17 men and 5 women) was $30.9{\pm}8.1(17\~44)$. The diagnosis before the surgery had shown 20 as accompanied with AR and the rest 2 as with ASR. The follow-up period ranged from 0.6 to 40.6 months, mean of $38.9{\pm}1.6\;months,\;and\;follow-up\;rate\;was\;100{\%}$. Result. There was no operative death and two late deaths, one of whom was cardiac originated and the other, non-cardiac relate The survival rate was $94.1{\pm}5.7{\%}$(40.6 months). Postoperatively there were 2 exploration for bleeding, 3 low cardiac output patients. The pulmonary autograft technique was root replacement in 14 and inclusion technique in 8. Pulmonary homografts were used at the pulmonary position in all cases. There was no patient with significant aortic regurgitation. Conclusion: These showed that the mortality and morbidity of the Ross procedure were acceptable and postoperative AR was not significant. However, further long-term follow-up will be necessary for the improvement of the function of pulmonary autograft and homograft.
Background: Despite recent advances in surgical technique and perioperative care of total anomalous pulmonary venous return (TAPVR), post-repair pulmonary vein stenosis (PVS) remains as a serious complication. We thought that the most important factors of TAPVR repair to prevent PVS were good exposure, proper alignment, and sufficient stoma size. We analyzed our experience retrospectively. Material and Method: Between Jan. 1995 and Feb. 2005, we studied 74 patients diagnosed with TAPVR suitable for biventricular repair. Supra-cardiac type (n=41, 55.4%) was the most common. Mean CPB time, ACC time, and TCA (40.5%, 30/74) time were $92.1{\pm}25.9\;min,\;39.1{\pm}10.6\;min$, and $30.2{\pm}10.7\;min$, respectively. Mean follow-up duration was $41.4{\pm}29.1$ months and follow-up was possible in all patients. Result: The median age and body weight at operation were 28.5 days ($0{\sim}478$ days) and 3.4 kg $(1.4{\sim}9\;kg)$. Early mortality was 4.1% (3/74). Causes of death were pulmonary hypertensive crisis, sepsis, and sudden death. There was PR-PVS in 2 patients (early: 1, late: 1). Both patients were cardiac type TAPVR drained to coronary sinus. Re-operations were done but only one patient survived. Cumulative survival rate in 5 year and percent freedom from PVS were $94.5{\pm}2.7%\;and\;97.2{\pm}2.0%$, respectively. Conclusion: There was no PVS in patients who underwent extra-cardiac anatomosis between LA and CPVC. Therefore it could be said that our principle might be effective in preventing PR-PVS in patients suitable two-ventricle.
Background: Mitral valve abnormalities in the pediatric population are rare. Mitral valve replacement or pediatric mitral lesions can cause problems such as a lack of growth potential. There re only limited experiences with mitral valve repair at any institution, so the purpose of his study is to evaluate the outcomes of mitral valve repair n pediatric patients. Material and Method: Sixty-four consecutive children (28 males and 36 females) with a mean age of $5.5{\pm}4.7$ years underwent mitral valve repair for treating their congenital mitral valve disease between January 1996 and December 2005. The patients were divided into two groups: group 1 (34 patients (53.1%)) had isolated disease (mitral anomaly with or without trial septal defect or patent ductus arteriosus) and group 2 (30 patients (46.9%)) had complex disease (mitral anomaly with concurrent intracardiac disease, except atrioventricular septal defect). Result: The overall in-hospital mortality was 6.3%; group 1 had 5.9% mortality and group 2 had 10.0% mortality. The postoperative morbidity was 18.8%; group 1 and 2 had 14.7% and 23.3% postoperative morbidity, respectively, and there as no significant difference among the groups. The median follow-up was 4.6 years range: $0.5{\sim}12.2$ years). The 10-year survival rate was 95.3%. The 10-year freedom from re-operation rate was 76.1% with 10 re-operations. The majority of the functional classifications were annular dilatation and leaflet prolapse. A mean of $2.1{\pm}1.1$ procedures per patient were performed. The echocardiography that was done at the immediate postoperative period showed a significant improvement in the mitral valve function. The follow-up echocardiographic results were significantly improved. However, mitral stenosis newly developed over time, and there ere significant differences according to the repair strategies. Conclusion: The patients who underwent mitral valve repair for congenital mitral anomalies showed good results. The follow-up echocardiography revealed satisfactory short-term and long-term results. Close follow-up is necessary to detect the development of postoperative mitral stenosis or regurgitation.
Kim, Jeong-Won;Lee, Jong-Tae;Cho, Joon-Yong;Kim, Kyu-Tae;Kim, Gun-Jik
Journal of Chest Surgery
/
v.41
no.5
/
pp.573-579
/
2008
Background: Composite valve graft replacement is currently the treatment of choice for a wide variety of the lesions of aortic root disease. The purpose of this study was to explore the results of aortic root replacement after using the Cabrol technique over a 13-year period at our institution, and we analyzed the results to help surgeons make better decisions when repairing aortic root disease. Material and Method: Between January 1994 and December 2006, twenty-five patients underwent a Cabrol technique operation at our institution. The mean patient age was $43.7{\pm}14.1$ years old (range: $6{\sim}65$ years) and the male and female ratio was 21:4 (84% : 16%). The patients' follow-up was 100% complete, and the mean follow-up period was $60.7{\pm}50.4$ (range:$1{\sim}162$) months. Annuloaortic ectasia (n=18) was the most frequent cause of aortic disease in this series, followed by aortic dissection (n=7). The mean cardiopulmonary bypass time was $177.2{\pm}44.9$ minutes and the mean aortic cross clamping time was $123.4{\pm}34.1$ minutes. Nine patients were checked with MDCT (Multidetector computed tomography) for evaluating a well functioning secondary graft and the coronary anastomosis site. Result: The early mortality rate was 4% (1 of 25 patients). A significant stenosis, kinking or occlusion of the secondary graft was detected by MDCT in 4 patients. The overall survival rate was 88%. Conclusion: The Cabrol technique demonstrated a significant incidence of long-term complications such as secondary graft stenosis or obstruction. It could be used when the modified Bentall technique is not feasible.
Purpose : In most cases, myelodysplastic syndrome(MDS) transforms into a more aggressive state or acute myelogenous leukemia; it's prognosis is very poor. It is believed that hematopoietic stem cell transplantation(HSCT) is the only curative treatment of MDS, but available data in children are very sparse. In this report, the short term outcome of HSCT in childhood MDS was analyzed. Methods : Ten children with MDS(CMMoL 5, RAEB 3, RAEBt 2) underwent HSCT(HLA-matched sibling transplantation 4, HLA-matched unrelated transplantation 4, cord blood transplantation 1, HLA-mismatched familial transplantation 1) between November 1995 and January 2001 at St. Mary's Hospital. Median follow-up duration was 11 months. Results : Engraftment was successful in all cases and 8 patients are alive without disease. Three cases of VOD were observed and improved without complication. Four cases of grade II and 1 case of grade III acute GVHD were observed and well controlled with treatment. Three patients relapsed after transplantation. One patient is alive without disease after cytoreduction with allogenic stem cell rescue and 2 patients died of relapse. Conclusion : HSCT is a curative strategy of MDS and the survival rate is relatively higher than that of adults. But there is an obvious need for more studies because of the small number of patients and the short duration of the follow-up.
Purpose : Rarity of olfactory neuroblastoma makes it difficult for treating Physician to Practice with a consistent protocol. This study is peformed to analyze our experience with various treatment modalities for patients with olfactory neuroblastoma. Discussion includes review of some recently published literatures. Methods and Materials : Between June of 1979 and April of 1997, 20 patients were treated under the diagnosis of olfactory neuroblastoma at Seoul National University Hospital. There were 14 male and 6 female patients. Age at initial treatment ranged from l3 to 77 years with median or 24 years. fifteen or 20 patients had Kadish stage C. They were treated with various combinations of surgery, radiation therapy and chemotherapy; surgery+postoperative radiation therapy+adjuvant chemotherapy for 2 patients, surgery+postoperative radiation therapy for 6, neoadjuvant chemotherapy+surgery for 1, surgery+adjuvant chemotherapy for 1, surgery only for 2, neoadiuvant chemotherapy+ radiation therapy for 3, radiation therapy+adjuvant chemotherapy for 1, radiation therapy only for 3, and no treatment for 1 patient. Results : Follow-up ranged from 2 month to 204 months with mean of 39.6 months. The overall 5- and 10-year survival rates are 20% and 10%, respectably. Four patients are alive at the time of data analysis. One of four living patients was treated with radical surgery, postoperative radiation therapy and adjuvant chemotherapy, two patients with radical surgery and postoperative radiation therapy, and one with radical surgery only. Conclusion : Multidisciplinary approach, including radical surgery, pre- or post-operative radiation therapy and chemotherapy, should be addressed at the initial time of diagnosis. Although limited by small number of the patients, this study suggests importance of local treatment modality, especially radical surgery in the treatment of lofactory neuroblastoma.
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